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Saturday, 16 November 2013
Learning Objective 1: Discuss the current state of nursing research surrounding how acute care nurses make decisions when encountering potentially life threatening, adverse patient changes.
Learning Objective 2: Identify the components of naturalistic decision making as it relates to acute care nurses decision making processes when encountering potentially life threatening, adverse patient changes.
Failure to rescue rose to the forefront of national healthcare concerns when it was identified in the late 1990s as one of the leading causes of avoidable inpatient hospital deaths (Institute of Medicine, 1999). Failure to rescue is conceptually defined as the lack of timely and appropriate response to patient complications resulting in cardiopulmonary arrest, injury or death (Silber, Williams, Krakauer, & Schwartz, 1992). One important area of focus is the point at which a complication evolves into a failure to rescue event. Warning signs of most complications can be distilled down into signs and symptoms that deviate from the patient’s typical baselines or expected values, herein referred to as adverse patient changes. In general, given that nurses are the healthcare providers who provide around-the-clock patient monitoring, recognizing adverse patient changes depends largely on nurses’ surveillance and vigilance (Clarke & Aiken, 2003). The acute care contexts in which these adverse patient changes occur are dynamic and complex – hospitalized patients are acutely ill with multiple co-morbidities, adverse patient changes are often subtle and ambiguous, and nurses’ ability to provide surveillance and vigilance varies given the acuity of their patients and their nurse-to-patient ratios. The challenge for the nurse surrounds not only identifying if an adverse change is occurring and determining the severity and implications of the change, but to decide on the best course of action. A synthesis of current research regarding nurses decision making processes in response to adverse patient changes, situated within the context of the naturalistic decision making framework, will be provided. This synthesis will offer insights into how acute care nurses may be best supported in making decisions regarding potential failure to rescue events, and will identify where further research may be needed.